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Wednesday, May 24, 2017

OMAHA — Three families will receive $18.4 million to settle their lawsuits over a 2002 medical helicopter crash in Norfolk that killed three people aboard.






We can learn from our history, or we can repeat it... Do you remember this crash?

Read the report and ask yourself, "what would I do differently if I had been in this pilot's seat?"

From the NTSB report...
"The helicopter impacted the terrain following a loss of control. Shortly after departing the hospital on a medivac flight, the pilot requested that company dispatch have the company mechanic meet him at a nearby airport because he was experiencing "binding in the right pedal."
An airport employee stated that just prior to the accident, she saw the helicopter hovering over the ramp and thought it was going to land.

Four other witnesses reported seeing the helicopter climbing and thought it was taking off. Witnesses also reported seeing the helicopter spinning (directions vary) prior to it descending to impact. One witness reported the nose of the helicopter was stationary on an east heading and the tail of the helicopter was swinging back and forth. He stated the helicopter then veered to the left and he lost sight of it when he traveled behind some buildings.
Another witness reported seeing the helicopter rocking nose to tail and going in a circle, but not spinning, prior to impact...

The guarded hydraulic cut-off switch was found in the off position.
Records show the pilot had approximately 2,500 hours of helicopter time with a total of 43.8 hours of flight time in this make and model of helicopter. Winds at the time of the accident were from 200 degrees at 16 knots, gusting to 21 knots.

The Federal Aviation Administration Rotorcraft Flying Handbook states that a loss of tail rotor effectiveness "may occur in all single-rotor helicopters at airspeeds less then 30 knots. It is the result of the tail rotor not proving adequate thrust to maintain directional control, and is usually caused be either certain wind azimuths (directions) while hovering, or by an insufficient tail rotor thrust for a given power setting at high altitudes."

(Editor's note, While the inclusion of this bit of information by the NTSB isn't technically erroneous, it indicates that they did not fully understand the causes of this crash, and simply listed things that may have been a factor. As it turns out, the tail-rotor on the Astar has tremendous authority, is on a long arm (the tail boom), and few pilots have ever mentioned LTE in the same sentence with the name Astar)

The National Transportation Safety Board determines the probable cause(s) of this accident as follows:
A loss of tail rotor effectiveness and the pilot's failure to maintain control of the helicopter. Factors associated with the accident were the binding of the tail rotor pitch changed rod, the gusty wind conditions, and the pilot’s lack of total experience in this make and model of helicopter.

We humbly suggest that the problem was not a lack of technical proficiency. The problem seems to have been the choices this pilot made. The problem was judgment or the lack of it.
Because there was no voice-recorder on board, we don't know when the pilot first became aware of a flight control problem. Was it as he came up to a hover off the pad? Was it on climb out? Was it in cruise flight?

One thing we do know however, is that at the first sign of problems with a flight control system, we should land - either as soon as possible or as soon as practicable, depending on the problem. Don't try and diagnose a flight control problem while flying. Land.

This pilot apparently was thinking about other things besides landing right now. It appears he was attempting to be a "team player" by requesting a technician to meet him at the airport. But what if he could have simply performed a precautionary landing at the first sign of trouble? When faced with a problem in flight, we will be better served by landing and sorting things out on the ground.
To include "how will maintenance find us?" Years after this event a pilot flew an Astar for 15 or 20 minutes with the red oil pressure light on. And then crashed.

When something is wrong - LAND. Better to over-react than under-react.
Maybe this pilot was worried about hovering with limited ability to control the tail rotor. And maybe that is why he headed to an airport. But if that was the case, shouldn't he have performed a run-on landing? Or a slow shallow approach? Or an autorotation? To the runway? Isn't that what we do when we lose tail rotor control? (depending on problem and rotorcraft EP...)
Maybe he didn't think his problem was a big deal. But then it was. It is unlikely that he took off with the hydraulic cutoff switch off, more likely that he was attempting to sort out a problem while flying. Instead of landing...

If you encounter a situation like this while flying; as soon as you get the aircraft to a state where you can control it, stop making changes to aircraft configuration and land. And if you have to run it on, do it. Don't hesitate to ask for help and execute the the most conservative response.
(while complying with the rotorcraft flight manual emergency procedure and company guidance...)

Disclaimer - This post is not intended to open old wounds or cause pain or discomfort to the families of those involved. The sole reason for these discussions is to learn, so that no one repeats this tragedy. If there is any good to come from a crash, it is that we learn how never to do that again. We also know that luck plays a part in any crew's life, and that on any given day it may be our turn to measure up - or not.

You can read more about this crash by clicking here.

Tuesday, April 25, 2017

Trust - But Verify!

Soviet–American relations. Suzanne Massie, a writer in Russia, met with President Ronald Reagan many times between 1984 and 1987. She taught him the Russian proverb, "Доверяй, но проверяй" {Doveryai, no proveryai} (trust, but verify) advising him that "The Russians like to talk in proverbs.
Wikipedia

Image courtesy Belfast Telegraph
Pilot Dara Fitzpatrick and her crew were lost as a result of a crash. There are lessons for all of us in this event. And if you do some soul-searching, you will realize that what happened to them could also happen to us. Take care. May God bless their souls and comfort their families.

"Ireland's Air Accident Investigation Unit (AAIU) released its preliminary report on the crash which stated that the helicopter's Honeywell Enhanced Ground Proximity Warning System (EGPWS), which alerts pilots to imminent danger from terrain and obstacles, does not include either the terrain of Blackrock island or the lighthouse on the island."

That single statement points towards a human-factors accident. A human failure to act that resulted in needless deaths.

We can never rely completely on a sole-source of information as to our position, safe-altitude, or hazards ahead. In the interest of true situational-awareness we must continually verify one source of information with another. Heading, altitude, destination, route to be flown... As well we must never put our complete faith in an onboard system. These systems are "aids," but the human at the pilot's station is the final defense should a system fail to operate as intended. If ANY system suddenly begins to malfunction - for instance if an autopilot suddenly commands an unexpected hard turn at the end of a coupled-approach - the pilot must be ready for this. He or she must be instantly ready to override the system and take manual control.

We cannot get so focused on the task, the mission, or outside distractions that we place responsibility for our safety on technology. The U.S. Federal Aviation Administration has warned that we are "addicted" to technology. The worry is that our basic airmanship skills have degraded, that we are becoming "direct-to-and-go pilots."

Tomorrow, 4.26.17 marks 13 months without a fatal HEMS crash in America.

We can never let our guard down.

Image courtesy Belfast Telegraph.

Click here to read full story from the Belfast Telegraph

Wednesday, April 5, 2017

Flights On The Bubble

I have been thinking about Chad Hammond the last few days, Chad was a well-liked and well-respected helicopter air ambulance pilot who, along with his crew and patient, were the last souls to be killed in a HEMS/HAA crash, as of this writing. The anniversary of their deaths was March 26th. As that date drew near, I wondered if we - collectively - could go a full year without killing anyone. And I hoped. I have come to know Chad's widow Natalin over the year since his death, and pondered his loss, and hers, at length. The NTSB report on this crash is not yet complete, so any discussion of cause is pure speculation. But I see similarities in this event and others, and I think it's worth a discussion between you and your HEMS team mates. It may well turn out that all assumptions about what happened to Chad and his team and patient are wrong. About the other events, there is no question.

As an Air Medical Resource Management instructor, I look for patterns and attempt to point these out when I find them - so that you might recognize a pattern as well. So that you might realize an accident chain is being welded together. So that you will not be the subject of a story like this.

And this morning I thought about HEMS flights on the bubble.

Are you familiar with this phrase, "on the bubble?" It normally refers to a team or team member who is right on the edge of not making the cut. It is often used in the context of a sport.  But it has another meaning. According to the Urban Dictionary "on the bubble" can be defined as...

At risk. In peril. Most often used to describe someone or something that may be cut from scope or removed from the group.

So the context I am considering is a flight that a HEMS pilot and crew are considering that is "just good enough to go"  The weather minimums that we VFR HEMS pilots use are pretty loose. Here they are.



So you can see that if we have night vision imaging systems or an approved helicopter terrain avoidance and warning system, our route is non-mountainous, and our destination is within our "local flying area," (as much as fifty nautical miles away from the base) the weather can be as low as 3 statute miles of visibility and 800 feet of clearance between earth and clouds for a night flight. Now, most flight teams understand that those numbers aren't used to start a flight, they are used to terminate one, but invariably some volume-conscious manager will push, or an over-zealous flight team will blast off hoping for the best.  Perhaps the pilot is seeing a trend of improvement and assumes the trend will continue. Never mind the fact that when we consider weather categorically, 800 and 3 is considered IFR, or instrument flight rules weather.

IFR = 500-1000′ and/or 1-3 miles

I imagine helicopter operators pushed for such low numbers and were given them by the regulators because some of the things we can do with a helicopter involve flights very close to the takeoff point, or flights at a very low speed, such as hovering over a grove of fruit trees to keep them from freezing on a cold winter's night, moving timber down a hill to a river, or hovering along next to a high tension power line. And of course, a helicopter can stop just about anywhere, even though many of us pilots have died because of a shocking reluctance to use this capability.

So let's consider the pilot who checks weather, and finds it "legal" and convinces the crew that all is well. As they proceed to the patient pickup point, things aren't great, but they are good enough to get by.

We are now flying "on the bubble."

We land on a scene or at a hospital pad, and the waiting game starts. Here is where we can get ourselves into trouble. We arrive on the bubble and while we wait it pops.

JALAPA -- Three times before dawn Tuesday, calls went out to emergency medical helicopters: A woman with a broken leg needed help along I-26 in Newberry County. 

Air rescue units from two Columbia hospitals and another in Greenville said it was too foggy to fly.

(added: One helicopter, "CareForce" from Richland Hospital in Columbia, launched and then aborted for weather.) 

A fourth call went to Spartanburg, where Regional One pilot Bob Giard checked the radar, decided the weather looked clear and took off with two crew members. 

The crew never reported problems with the weather en route to the site. But minutes after picking up the patient, their helicopter crashed in woods near the Palmetto Trail, about 1,000 yards from an I-26 rest area, authorities said. 

Giard, 41, flight paramedic David Bacon, 31, nurse Glenda Frazier Tessnear, 42, and an unidentified female patient died.  (text courtesy Associated Press)

Here is a bit from the NTSB on this crash.

"A single-engine emergency medical services (EMS) helicopter was destroyed after impacting trees in a national forest about 0532 eastern daylight time. Night visual meteorological conditions with mist and light fog prevailed in the area of the accident site. The flight crew was contacted about 0452 to determine if they could accept the mission. The pilot performed a weather check and accepted the mission about 0455. He departed about 0502. The helicopter arrived at the accident scene and landed on the interstate highway near a rest stop about 0523. The helicopter departed the scene about 10 minutes later, flying toward the national forest located north of the interstate. A witness reported that the helicopter made no abrupt maneuvers and that the engine "didn't sound like it was missing, sputtering, or any other kind of power loss." He reported that the helicopter was straight and level then it "pitched forward to go forward." He reported the helicopter was "flying level" as it descended into the trees. He reported that the helicopter's searchlight was on and that fog and mist were visible at treetop level. Postaccident inspection of the helicopter revealed no preexisting anomalies that could be associated with a pre-impact condition. Download of the engine's electronic control unit nonvolatile memory indicated that the engine was operating at 98 percent Ng when it impacted the trees. Three other EMS helicopter operators had turned down the mission, including one who had attempted it but had to return because of fog conditions. However, the accident pilot was not informed that other pilots had declined the mission because of fog."

Now maybe you are thinking that "about 10 minutes" isn't long enough for weather to go from just above minimums to well below them, but I assure you, saturated air can go from muggy to foggy very quickly. Giving this crew the benefit of the doubt, and assuming they weren't breaking the law on the way to the patient, one must surmise that conditions deteriorated while they sat on the ground at the scene. And sadly, they decided they had to go anyway.

When I was doing AMRM for Omniflight, I was privy to event reports in which pilots described adverse flight scenarios they had lived through. I used these redacted reports for classroom discussions so that we might learn from someone else's "thrilling" moments. In one such event report a pilot recounted a night flight to a patient in which he noticed the weather deteriorating and decided to abort and return to base. The requestor, a ground-based ambulance crew, asked if the aircraft and crew might stop somewhere mid-trip for a linkup and patient transfer. So after doing a 180, this pilot landed and waited for the ambulance to show up. And as he and his crew waited they observed the weather getting worse and worse. Finally, he had had enough and he set about departing for his base. But just as they came up to a high hover, the ambulance pulled into the parking lot!

This is a very uncomfortable position to be in as a pilot. I have been there and done it wrong. I didn't want to disappoint the "customers," (the ambulance crew) and I didn't want to leave the patient in the lurch.

So as this pilot and his crew see the bus pull up, somebody decides to land and load in a hurry and hope for the best. The next few minutes were undoubtedly an experience that none of them will ever forget. The text in the event report went something like, "I took off and got into the clouds and could no longer see the ground. I lost control. The aircraft spun to the left and spun to the right, then I got on the instruments and regained control. I flew on to the receiving hospital." In actuality, there was a little bit more to it. I presented this case study at this pilot's base, not knowing who he was or where he worked, and after the class he confessed to me that it had been him. I now have the utmost admiration for this man's courage and candor, because he rightly assumed that his experience might be repeated. So he volunteered to tell his story in a video sponsored by Airbus Helicopters.

You can watch this video, titled "That Others May Live" here.  It is chock full of lessons, and it has undoubtedly saved some lives.






So now let's consider the most recent fatal crash. Here is a bit from the initial NTSB report,

"On March 26, 2016 about 0018 central daylight time, a Eurocopter AS 350 B2, N911GF, impacted trees and terrain near Enterprise, Alabama. The airline transport pilot, flight nurse, flight paramedic, and patient being transported, were fatally injured. The helicopter, registered to Haynes Life Flight LLC. and operated by Metro Aviation Inc. was substantially damaged. The flight was operated under the provisions of Title 14 Code of Federal Regulations Part 135, as a helicopter emergency medical services flight. Night instrument meteorological conditions (IMC) prevailed for the flight, which operated on a company visual flight rules (VFR) flight plan. The flight departed from a farm field near Goodman, Alabama about 0017, destined for Baptist Medical Center Heliport (AL11), Montgomery, Alabama.

According to the Coffee County Sherriff's Office, on March 25, 2016 at approximately 2309, a 911 called was received when a witness observed a motor vehicle accident on County Road 606 near Goodman, Alabama. Sheriff's deputies were dispatched along with Enterprise Rescue Squad. Deputies also contacted Haynes Life Flight dispatch, when it was discovered that the vehicle was overturned and that an unconscious victim was inside.

According to communications records, the call from the deputies was received by Haynes Life Flight Dispatch at 23:19:10. The pilot of "Life Flight 2," which was based at the Troy Regional Medical Center, Troy Alabama was notified at 23:20:38. The helicopter departed Troy at 23:26:57 and arrived at the landing zone (LZ) in a farm field adjacent to County Road 606 at 23:53:15.

According to witnesses, after touchdown, the pilot remained in the helicopter with the engine running. The flight paramedic and flight nurse exited the helicopter and entered the Enterprise Rescue Squad ambulance to help prepare the patient for transport. Once the patient was ready for transport, the flight nurse and flight paramedic along with several other emergency responders rolled the gurney approximately 70 yards through a grassy area to the helicopter and loaded the patient on-board. Once the patient had been loaded, the flight nurse and flight paramedic boarded, and at 00:16:45 the helicopter lifted off and turned north towards AL11.

Fog, mist, and reduced visibility existed at the LZ at the time of the helicopter's arrival. Witnesses also observed that these same conditions were still present when the helicopter lifted off approximately 23 minutes later. The helicopter climbed vertically into cloud layer that was approximately 150 feet above ground level and disappeared when it turned left in a northbound direction toward AL11. Review of the recorded weather at Enterprise Municipal Airport (EDN), Enterprise, Alabama, located 4 nautical miles east of the accident site, at 0015, included winds from 120 degrees at 4 knots, 3 statute miles visibility in drizzle, overcast clouds at 3oo feet, temperature 17 degrees C, dew point 17 degrees C, and an altimeter setting of 29.97 inches of mercury."

So, do you see a pattern? We get to the patient, and the weather gets worse, and for whatever reason we give it a shot. None of these pilots were bad people. They weren't dumb. They were respected and liked and loved. And they certainly didn't walk out to their aircraft thinking "tonight's the night." And yet they all took off into weather that was bad enough so that even a medical crew member walking back from the bus to the aircraft should have been able to look up and realize that a VFR aircraft was in for trouble.

So that's exactly what I will ask you medical crews to do. Be aware of the weather where you are. And be aware of how a pilot's mind works. He or she wants to get the job done. We want to help the patient and avoid disappointing anyone. But in our efforts to do this, in some cases, we cause disappointment beyond belief. YOU may be the person who says, "hey friend, while we have been here things have gotten worse. So I am making the call. We are going by ground." (If your program permits that option, if not maybe you should not go at all.)

Flights on the bubble put us at risk, in peril. I don't want you to be cut from the scope of our business, or removed from the group.



Safe Flights friends...








Tuesday, March 7, 2017

Accident Review. What would you differently?



Lipperer, who grew up in the Jefferson area, became a pilot for UW Hospital and Clinics in 2000. He was employed by Air Methods, the company that leased the aircraft to the hospital. He was known for his flying skills, and colleagues felt safe getting into an aircraft with him, said Cisler, the hospital's director for emergency services.

"He was very thorough, very safety conscious, just smart at what he does," Cisler said.

Lipperer had worked for Air Methods since 1995 as both a mechanic and pilot, said Aaron Todd, the company's chief executive officer.

NTSB Identification: CHI08FA128
14 CFR Part 91: General Aviation
Accident occurred Saturday, May 10, 2008 in La Crosse, WI
Probable Cause Approval Date: 09/02/2010
Aircraft: EUROCOPTER DEUTSCHLAND GMBH EC 135 T2+, registration: N135UW
Injuries: 3 Fatal.
NTSB investigators either traveled in support of this investigation or conducted a significant amount of investigative work without any travel, and used data obtained from various sources to prepare this aircraft accident report.

After transporting a patient to a local hospital and refueling at La Crosse Municipal Airport (LSE), the emergency medical services (EMS) helicopter departed LSE (elevation 656 feet mean sea level [msl]) about 2234 central daylight time (all times in this brief are central daylight time) on a return flight to its base heliport. Dark night visual meteorological conditions (VMC) prevailed at LSE. A ramp services employee at LSE who had observed the helicopter lift off and proceed east-southeast observed “moderate” rain and “fair” visibility at the time of takeoff. Witnesses located southeast of the airport reported hearing the helicopter in flight about the time of the accident, and one witness reported hearing a loud crashing sound. A search was initiated shortly after the crash but was hampered by the terrain and fog that had formed overnight. A search located the helicopter the following morning; the helicopter had impacted trees along a sparsely populated ridgeline about 5 miles southeast of LSE. The elevation of the ridgeline was approximately 1,164 feet msl, with 50- to 60-foot-tall trees in the area initially struck by the helicopter.



Distribution of the wreckage was consistent with the helicopter impacting the trees in a nearly level flight attitude under controlled flight. Examination of the helicopter’s engines revealed inlet debris, rotational scoring, and centrifugal turbine blade overload failures consistent with the engines being operated at a moderate to high power level (on both engines) at the time of impact. Nonvolatile memory downloaded from the digital engine control units (DECUs) indicated that both engines were in “flight mode” at the time of impact. Although the left engine main selector switch was observed in the “idle” position after the accident, the lack of anomalies related to the switch and the corresponding DECU in flight mode are consistent with the switch having been moved as a result of impact. No preimpact mechanical malfunctions of the helicopter were found.

The reported weather conditions at LSE about 2253 included VMC: calm winds, 8 miles visibility in light rain, few clouds at 1,400 feet above ground level (agl) [2,056 feet msl], overcast clouds at 5,000 feet agl (5,656 feet msl), temperature 10 degrees C, dew point 8 degrees C, and altimeter 29.70 inches of mercury. The preflight weather briefing obtained by the pilot about 1 hour before departure indicated VMC along the route of flight at the time of the briefing but forecasted deteriorating conditions later in the evening after about 2200, including possible instrument meteorological conditions (IMC). Search and rescue personnel reported fog and mist along the ridgeline overnight during the search operations. Additionally, an EMS pilot for another operator reported that when he departed LSE about 2 hours before the accident flight, fog was beginning to form on the west side of the Mississippi River and in the bluffs east of his flight route. He subsequently returned to LSE and declined at least one additional flight that evening due to deteriorating weather conditions. Because of the variability in weather conditions on the night of the accident, the investigation could not determine if the pilot encountered IMC at the time of the accident.

The pilot was transferred to the accident operator as a result of the accident operator’s acquisition of his previous employer about 3 months before the accident. The accident pilot was initially qualified as visual flight rules (VFR)-only. An instrument proficiency check was not completed in conjunction with initial training. As a result, the accident pilot was limited to VFR-only operations at the time of the accident. (The accident pilot was current for instrument flight rules [IFR] at his previous place of employment.) 

During preflight planning, the pilot should have identified any obstacles along the route of flight, including the tree-covered ridgeline. Company records indicated that the pilot had completed one prior flight to LSE within the previous 16-month period, which was about 2 months before the accident. To assist pilots, maximum elevation figures (MEF) are noted on sectional charts and are derived from such features as terrain, trees, and towers. An MEF is specified for each latitude/longitude quadrangle on the chart. Operation at or above the applicable MEF will ensure terrain and obstacle clearance. The MEF for the La Crosse area is 2,200 feet msl. In addition to the MEF, sectional charts depict terrain elevation and specific obstacle height information. If the accident pilot had observed the MEF of 2,200 feet msl, or the terrain elevation/obstacle height information, it would have provided clearance of the tree covered ridgeline. The elevation of the ridge in the vicinity of the tree strikes was approximately 1,164 feet msl. With the 50- to 60-foot-tall trees, the elevation of the treetops was about 1,224 feet msl, providing a margin of approximately 831 feet to the level of the reported “few clouds” and 4,431 feet to the overcast layer of clouds.

According to Air Methods Corporation, the accident pilot performed a formal flight risk assessment before the flight. Further, the flight was being tracked by a company flight-following program and received flight dispatch services before the start of the flight. According to the Air Methods General Operating Manual, the pilot’s risk assessment was to be recorded in the pilot’s daily flight log. However, the pilot’s daily flight log was destroyed during the crash. The pilot entered a risk assessment of “A” (normal operations) into the flight dispatch computer system before the flight. While the weather in the LSE area was marginal at the time of the accident, it was above the minimums required by Federal Aviation Administration (FAA) regulations and the operator’s procedures. There were no identified weather risks that would have warranted classifying the flight in the risk assessment category “B” (caution).


Tuesday, February 21, 2017

"Discretion Is The Better Part Of Valor..."


     "Caution is preferable to rash bravery." Falstaff in King Henry the Fourth, 
by William Shakespeare


The pilot's decision to land during unfavorable wind conditions, which resulted in a loss of control due to settling with power. Contributing to the accident were the lack of an adequate approach path due to numerous obstructions and the lack of available guidance regarding the helicopter's performance capabilities in the right quartering tailwind condition.




NTSB: HISTORY OF FLIGHT

On March 6, 2015, at 2310 central standard time, an Airbus Helicopters (Eurocopter) EC-130-B4, N356AM, ... struck the edge of a hospital building and impacted its parking lot during a visual approach to the St Louis University Hospital elevated rooftop helipad (MO55), St Louis, Missouri. During the approach, the helicopter experienced a loss of directional control and entered an uncontrolled descent. The helicopter was destroyed by impact forces and a post-crash fire. The commercial pilot, who was the sole occupant, sustained fatal injuries. The helicopter was operated under Title 14 Code of Federal Regulations Part 91 as an air medical positioning flight that was operating on a company flight plan. Night visual meteorological conditions prevailed at the time of the accident. The flight was returning to MO55 after it had been refueled at the operator's base located at Arch Heliport (MU05), St. Louis, Missouri. The flight's first approach and landing at MO55 was to drop off a medic, nurse, and a patient, who was not in critical condition. The flight release for the flight and the accident flight had a green weather status, whose criteria is solely based upon ceilings and visibility. The risk assessment, which was completed for the flight and not for the accident flight, was assessed as low. The medic said that he had been employed as a medic for about a year and flew on previous flights that landed at MO55 "couple of times" and had flown with other (company) pilots. The nurse stated that she began employment at (the company) in January 2015 and she had two years of experience with another aviation company. The medic stated that during the first approach for landing to MO55 with the pilot, the pilot said that there was a 25 knot wind, but the medic did not know the source of the pilot's wind information. The medic said that the wind sock on the helipad was illuminated and pointing "straight out" towards the elevator shaft (the elevator shaft was located toward the northeast) next to the helipad. During the approach, the helicopter tail was "sideways a little bit." The pilot said it was going to be "a little rough" and that "it was a little windy." The medic said that the approach was "straight-in," and he felt a "little drop" when they came in. The helicopter did not slow down during the approach. The approach felt lower than usual and about 10-20 feet lower than that used by other pilots he had flown with and seemed closer to the elevator than the middle of the helipad while the helicopter was about a "football field" or "half of a football field" away from the helipad. The nose of the helicopter was directed away from elevator and the pilot would "straighten out" the helicopter when it was closer in. The nurse said that there was "a lot of rolling" and "a lot of yawing" during the approach to MO55. Over the helipad, the pilot was having a "hard time" and "a couple of more seconds" she would had told him to abort the landing and to do another "recon." The medic said that after landing, the pilot needed to shut down the helicopter at MO55 to remove a helicopter seat. After the helicopter shutdown, the pilot said that he wanted to stay on the helipad, but the medic told the pilot that the helicopter could not remain on the helipad because there were other helicopters coming in. The nurse stated that it was not a "typical thing to do" to have the helicopter remain on the helipad because other helicopter arrivals. The nurse stated that the pilot did not tell her why he wanted to remain on the helipad, but her "gut reaction was that it was a hard landing and he did not want to do that again." She said it was "difficult" to get the helicopter skids onto the helipad. The flight then departed to obtain fuel at MU05 (located about 1.3 nautical miles from MO55). Upon refueling, the flight returned to MO55, to pick up the medic and nurse. Neither the medic nor the nurse saw the helicopter takeoff from MO55 for the flight to refuel at MU05. The nurse stated that at 2258 she sent a text message to the pilot stating that they were ready to be picked up from MO55, and he responded in text that he was on his way. She said that at 2309, she looked at the time and thought it was "taking a while for his return." The accident occurred during the flight's return, during approach for landing, at MO55. A witness stated that he was sitting in his truck parked across from the St Louis University Hospital emergency room when he saw a light shine on his truck, "the light was coming closer and closer." After a while the light turned around and disappeared "quick." The light shined for about two minutes. His truck was facing west because it was parked on Vista, which is a one way street. The light shined on the truck for about two minutes. The light turned sideways, and it was a clear white light. The other lights he saw on the back of the helicopter "looked like red and green" from the tail. He said he could not hear the helicopter. The helicopter was "coming forward" and it took a "little tail spin" before it went out of sight. The helicopter went north and "went down." He saw the helicopter "side" and "back" and then it went down. He did not see any fire from the helicopter before the accident. He did not hear any noise after it went out of sight. He said that his truck was parked across from the hospital ambulance entrance. He said the helicopter made a "regular turn" and he could see its side, which was to his left before it went down. He saw it "spin only once and not more." He said the helicopter was pointing "straight down as it turned left." He said it was not "quite straight down" and the light was shining on the ground as it was going down on an angle. He said that he did not see the helicopter "wobble." He said a security guard came out and walked down Thistle. The witness said he got out of his truck, and the wind was "going pretty hard" going north. He said that helicopter was about 15 feet above the overhead tunnel between the hospital and hospital garage. He did not see the bottom of the helicopter because of the light. He said the wind was not shaking his truck when he was sitting inside of it. PERSONNEL INFORMATION The pilot held a commercial pilot certificate with rotorcraft-helicopter and instrument-helicopter ratings issued on June 24, 1992. Air Methods reported on National Transportation Safety Board (NTSB) Accident Pilot/Operator Aircraft Accident/Incident (Form 6120) that the pilot accumulated a total time of 2,614 hours, all of which was in rotorcraft. According to the FAA blue ribbon airman certification file for the pilot, he was issued a commercial pilot certificate based upon military competence obtained in the US Army and had flown at least 10 hours as pilot-in-command during the last 12 months in the following military aircraft: UH-1. Section III, Record of Flight Time was not completed upon the application for his commercial pilot certificate with rotorcraft-helicopter and instrument-helicopter ratings. A record of his military competence, Army DA Form 759, Individual Flight Record and Flight Certificate, was not in the airman certification file nor was it required to be submitted by the examiner that issued the pilot's commercial pilot certificate. The pilot had applied for employment as a pilot at another EMS operator in the summer of 2013. According to the operator's regional director of flight operations during that time, he interviewed the pilot and went through the pilot's qualifications using the pilot's resume. The director of flight operations stated that he did not feel confident in the pilot's flight times. Another regional director for the EMS operator called someone at Ft. Campbell, Kentucky to verify if the pilot's PIC flight time in AH-64 helicopters and found out that the pilot had "very limited PIC time in the AH-64." The director of operation that had interviewed the pilot said that following the interview, the pilot contacted him 2 or 3 times but was told he was not being considered for employment. The pilot did not provide Army Form 759 for the EMS operator following the interview. According to the pilot's resume that was on file with (the company), he had been previously employed as a EC-130 pilot by for air tour operations as of May 5, 2013 and listed his total flight time prior to his employment at (the company) as 2,244.7 hours, "military helicopter" of 2,244.7 hours, and pilot-in-command (PIC) time of 1,155.7 hours. The "type ratings" listed on the resume were: Airbus Helicopters (Eurocopter) EC-130-B4, Bell UH-1, Bell AH-1, Boeing AH-64A and Bowing AH-64D helicopters. The pilot's date of hire with Air Methods was October 21, 2013 and he reported, on his application for employment dated October 22, 2013, a total aircraft time all of which were in helicopters 2,503.4 hours, 1338.8 hours PIC, 168.7 hours at night unaided, and 674.8 hours with night vision goggles. He reported upon the application, that he had the following flight times by aircraft make and model: EC 130-B4 – 250 hours, UH-1 and AH-1 – 233 hours, and AH-64 – 2,015.4 hours. The pilot reported on his application that he had 0 years of experienced working as an air medical pilot under Part 135 and had 0 hours of air medical flight time. On November 20, 2013, the pilot successfully completed his initial Part 135 293a, 293b, and 299 checkride provided by a company check airman for EC130 helicopters and his transition to EC130 NVG on the same date. On December 1, 2013, he was assigned as an EC130/EC130NVG pilot based at R07. (The company) and the pilot's previous employer did not have a copy of the pilot's Army Form 759. A copy of the form was requested from the pilot's wife by the National Transportation Safety Board (NTSB) Investigator-In-Charge (IIC), but the form was not received during the accident investigation. The pilot had no previous FAA record of incident, accidents, or enforcement actions. AIRCRAFT INFORMATION N356AM was a 2010 Airbus Helicopters (Eurocopter) EC-130-B4, serial number 7006, which was configured for EMS operations under Part 135. The helicopter was powered by a Turbomeca Arriel 2B1 turboshaft engine, serial number 46489. The helicopter underwent its last inspection on March 5, 2015 at an airframe and engine total time of 1,378.4 hours, which was also the engine total time since new. METEOROLOGICAL INFORMATION The 2100 sounding wind profile indicated there was a surface wind from 183 degrees at 7 knots and the wind speed increased to 25 knots by 1,300 feet msl and became southwesterly. The sustained wind speed reached up to 30 knots at 2,000 feet msl. At 0000, similar wind conditions persisted though the inversion height now reached up to 2,100 feet msl with the wind speed around 40 knots at 2,000 feet msl, just below the top of the inversion height. This inversion height is critical with the stable air below 2,000 feet msl, as any mixing of the wind speed and direction below 2,000 feet msl would have caused moderate or greater turbulence and low-level wind shear (LLWS). RAOB also indicated likely LLWS below 3,000 feet msl at both 2100 and 0000 CST along with clear air turbulence being likely from the surface through 6,500 feet msl. As soon as the accident flight took off it would have likely experienced LLWS, clear air turbulence, and wind speeds up to 40 knots between the surface and 2,000 feet msl. Given the upper air charts, these wind speeds above the surface would have been expected. AIRPORT INFORMATION Destination Helipad The MO55 helipad is privately owned and was not subject to meeting regulatory requirements for helideck design requirements by the FAA and adherence to those regulatory requirements were voluntary. A letter by an FAA Airports Airspace Data Specialist, dated August 19, 1986, stated that following an on-site inspection of MO55 on May 7, 1986 or the 210 foot by 150 foot landing/takeoff area and a 50 foot by 50 foot touchdown area. The letter stated that there is adequate ingress/egress greater than 8-1, in two directions, 180 degrees apart. The letter stated that the aeronautical study of the proposed heliport [MO55] would adversely affect that safe and efficient use of airspace by an aircraft unless the following conditions are maintained: 1. Clear approach/departure paths to the landing area for a minimum 8:1 glide slope . Obstruction clearance planes (glide slope), aligned with the direction of the approach/departure paths, extend outward and upward from the landing/takeoff area to the en route altitude at an angle of 8 feet horizontally to 1 foot vertically (8:1). 2. A clear transitional surface for a minimum 2:1 slope. The transitional surface extends outward and upward from the edges of the landing/takeoff area and approach/departure clearance planes at an angle of 2 feet horizontally to 1 foot vertically (2:1) to a distance of 250 feet from the center of the landing and takeoff area and 250 feet from the centerline of the approach/departure clearance surfaces. The NTSB IIC requested that the FAA perform post-accident inspection of MO55, which was performed on April 16, 2015. The inspection results were documented in a Heliport Safety Evaluation Report, Case Number: 2015–ACE–1749–NRA. The report cited 10 obstructions within the final approach and takeoff area (FATO)/safety area of the heliport/helipad and 4 obstructions outside the FATO/safety area. The 10 obstructions outside the FATO/safety area had a ranged in azimuth from 005 – 236 degrees and there were no obstructions from 236 – 005 degrees, or west, northwest. Figure 1: Obstructions Outside the FATO/Safety Area Figure 2: Obstructions Inside the FATO/Safety Area The report's recommendations for ingress/egress stated: "The heliport FATO/safety area is obstructed by permanent and semi-permanent objects that pose a serious hazard to helicopter operations. The most serious obstructions cannot be easily lowered or removed. Flight Standards cannot recommend an approach/departure route into or out of a hazardous area that does not appear to have reasonable alternatives for mitigation. Therefore, no recommendation for ingress/egress is made in this case." The medic said if there is a lot of wind, it is "always weird" coming in for approach to land at MO55. The nurse said that her knowing the area and the St Louis University Hospital helipad (MO55), she knew that it was going to be a "hard landing" on a good day." A pilot that was not employed by (the company) stated that he had flown in a Eurocopter "a handful of times. He said that flying into MO55 "is not the hardest pad but it's a difficult pad especially when the winds are at different angles and you have a lot of mechanical turbulence." The winds come around the building and can create a tailwind. Obstructions to the pad are the elevator shaft and buildings surround the pad. He takes new hire helicopter pilots and shows them the mechanical turbulence associated during flight training. He said that if "don't get set up at the right altitude and closure rate" for at MO55, you can "find yourself in a bad situation." He said the Baris hospital is "definitely more difficult to get into [than] MO55; you can have a headwind one minute and have a tailwind the next minute." He flies a Bell 206, which he said is not as strong as a Eurocopter 130 tailrotor. You can get into loss of tail rotor effectiveness approaching the wrong way during landing. His personal wind limitations are 25 knots with a gust spread of 10-12 knots. He feels "comfortable" with "steady winds of 25 knots." He said the Cardinal Glennon (MU52) hospital had a ground based helipad and using a ground pad required an arrangement to be made to transport a patient via an ambulance to the ground pad. Nearest Ground Based Helipad The nearest ground based helipad was MU52, which was located about 0.4 nautical miles west of MO55. The availability and its method of ground transportation from MO55 to MU52 prior to the accident was unknown to the investigation. WRECKAGE AND IMPACT INFORMATION The main wreckage of the helicopter was located near the west parking lot entrance of the hospital. The wreckage and its debris were over an area estimated to be about 30 feet in diameter. The helicopter was oriented approximately toward the northeast as viewed from its tail to nose. There were blue colored witness marks alongside the top of the northern side of the west entrance for the building that were consistent with a strike by the helicopter tail. Examination of the wreckage confirmed flight control continuity of the tail rotor drive system. Due to impact and fire damage, functional testing of the flight control system could not be performed. Examination of the engine revealed that several of the axial blades exhibited foreign object damage. The gas generator and accessory gearbox could not be rotated by hand. The free turbine blades did not shed and could not be rotated by hand. The engine and helicopter were recovered to a salvage yard for further investigation. All fuel, oil, and air connections were attached and their hoses sustained fire damage. The digital engine control unit was destroyed by fire. The accessory gearbox magnetic plug was broken due to impact forces and could not be examined as well as the electronic chip detector. The reduction gearbox magnetic plug did not display metallic debris. The oil and fuel filters did not contain debris. The reduction gearbox was removed and the input pinion alignment mark was in the over-torqued 4mm position, consistent with the engine providing power. Upon removal of the gearbox, the free turbine could be rotated by hand but the powershaft still could not be rotated. The front support and liaison tube were removed and then the powershaft rotated freely and proper freewheel operation was confirmed. MEDICAL AND PATHOLOGICAL INFORMATION An autopsy of the pilot was conducted by the Office of the Medical Examiner City of St. Louis on March 7, 2015. The autopsy report stated the cause of death as "Thermal Burns and Smoke Inhalation." The FAA Final Forensic Toxicology Fatal Accident Report of the pilot stated: no carbon monoxide detected in Blood (Femoral), cyanide- not performed, volatiles – no ethanol detected in vitreous, drugs – no listed drugs detected in urine. FIRE A post-crash fire and explosion occurred upon impact when the helicopter impacted the parking lot adjacent to the building entrance which was captured by a security video. The following two frames from a security camera show the explosion and fire that ensued after the helicopter's impact. Figure 3: The top video frame at 11:17:14 PM shows the fire/explosion during the impact of N356AM and the bottom frame at 11:17:17 PM shows a fire ball separated from the initial fire and moved upwards and to the left of the screen in a direction consistent with approximate wind direction. SURVIVAL ASPECTS The autopsy determined the cause of death was thermal burns and smoke inhalation. It described severe thermal injuries to the entire body including multiple thermal fractures and soot deposition in the respiratory tract from the trachea to the bilateral bronchial tree. Traumatic injuries included a hairline fracture of the frontal bone, a sternal fracture, and a fracture of the fifth cervical vertebra without evidence of a spinal cord injury. Subarachnoid blood was attributed to extension of blood from the fracture in the cervical spine. The autopsy identified coronary artery disease including 80 percent narrowing of the left anterior descending coronary artery. However, no focal lesions (evidence of an old or new heart attack) were identified in the heart muscle. On March 23, 2016, the NTSB issued Safety Recommendations A-16-11 and A-16-8 through -10 pertaining to Airbus Helicopters EC-130-B4 and AS-350-B3e. Two 2015 accidents, one of which involved N356AM, had impact forces survivable for occupants but fatal and serious injuries occurred because of postcrash fires that resulted from an impact-related breach in the fuel tanks. TESTS AND RESEARCH Aircraft Performance Study There was no sufficient radar data or nonvolatile memory aboard the helicopter to perform a performance study of the helicopter's accident flight. Security Video A review of the security video cited in the Fire section of this report, showed at about 11:16:52 PM, a light consistent in white color and shape of the helicopter landing light shining onto the hospital building facing the parking lot entrance where the helicopter later impacted. The light then moves toward the right edge of the building and about 11:17:03 PM, the light moves left, off the building. About 11:17:06 PM, a flash of white colored light appears in the camera. About 11:17:08 PM, the light moves from right to left across the hospital building face as a declination at an estimated approximate angle of 45 degrees. About 11:17:11 PM, the helicopter comes into view and descending at a similar declination angle and direction as was the light. Settling With Power (Vortex Ring State) According to the Helicopter Flying Handbook (FAA-H-8083-21A), Chapter 11, Helicopter Emergencies and Hazards: "Vortex ring state describes an aerodynamic condition in which a helicopter may be in a vertical descent with 20 percent up to maximum power applied, and little or no climb performance. The term "settling with power" comes from the fact that the helicopter keeps settling even though full engine power is applied. In a normal out-of-ground-effect (OGE) hover, the helicopter is able to remain stationary by propelling a large mass of air down through the main rotor. Some of the air is recirculated near the tips of the blades, curling up from the bottom of the rotor system and rejoining the air entering the rotor from the top. This phenomenon is common to all airfoils and is known as tip vortices. Tip vortices generate drag and degrade airfoil efficiency. As long as the tip vortices are small, their only effect is a small loss in rotor efficiency. However, when the helicopter begins to descend vertically, it settles into its own downwash, which greatly enlarges the tip vortices. In this vortex ring state, most of the power developed by the engine is wasted in circulating the air in a doughnut pattern around the rotor. Critical Wind Azimuth or Maximum Safe Relative Wind Chart According to the Helicopter Flying Handbook, Chapter 7, Helicopter Performance: "The wind direction is also an important consideration. Headwinds are the most desirable as they contribute to the greatest increase in performance. Strong crosswinds and tailwind may require the use of more tail rotor thrust to maintain directional control. This increased tail rotor thrust absorbs power from the engine, which means there is less power available to the main rotor for the production of lift. Some helicopters even have a critical wind azimuth or maximum safe relative wind chart. Operating the helicopter beyond these limits could cause loss of tail rotor effectiveness." Air Methods operates two other makes and models of single-engine helicopters, a Bell 407 GX and an AgustaWestland AW 119, both of whose flight manuals provide speed/azimuth wind charts. A review of the EC 130-B4 flight manual does not provide speed/azimuth envelope and the only guidance provided for the helicopter's stability and control relative to speed/azimuth was: A review of the Eurocopter EC 130 B4 Flight Manual, Revision 9, revealed that the manual did not contain wind limits nor critical wind azimuth or maximum safe relative wind chart. During the accident investigation, the NTSB Investigator-In-Charge requested that Airbus Helicopters perform a critical azimuth analysis and in response to that request, Airbus Helicopters provided the following charts showing pedal control and power required to maintain an out of ground effect hover relative to azimuth/wind speed. Figure 4: The plot shows percentage of foot position versus azimuth at wind speeds from 0-50 knots. The left stop limit occurs at azimuths of about 103 degrees to 138 degrees with a wind of 50 knots. The right pedal stop occurs at azimuths of about 230 degrees to 253 degrees at a wind speed of 40 knots; the azimuth range for the right pedal stop increases with increasing wind speeds of 45 knots and 50 knots. Figure 5: Plot of power necessary versus azimuth at wind speeds from 0-50 knots. The upper limit of power occurred at approximate azimuth of 223 degrees to 290 degrees with a wind speed of 50 knots. Perspective of Handling Qualities of the EC-130-B4 A pilot flying emergency medical service helicopters since 2004. He said he had flown helicopters that included the BK136, EC130, Jet Ranger and "Hughey." He has a total flight time of about 17,000 hours, of which 9,700 hours are in helicopters. He said he had flown Chinook, Black Hawk, and OH58 helicopters. He stated that flying into MO55 is "not that bad" for those pilots who are used to flying into confined areas. He said that the approach into MO55 is "almost a one way in and one way out." If there is a right or left crosswind, the approach into MO55 can be difficult but nothing that an experienced pilot can handle. He said that the EC130 vertical fin is "extremely affected by a lot of wind," and he had to apply tail rotor pedal input to the pedal stops on certain occasions. The pedals are not boosted but are manual. He said that about every 100 hours or "a little over," the EC130 can have exhaust gases contaminate the blade roots of the Finestron. There is Teflon tape on the blade roots that allow for blade mobility. The exhaust contaminate may cause the blades to stick, which "can be felt in the rudder pedals." He said that in "only extreme cases the blades will stick." When asked what his personal wind limits were, he said that if he is not "comfortable" with an approach/landing, he will fly to another landing zone. Accident Flight Risk Assessment The pilot completed a company risk assessment form dated March 6, 2015 with a time of 1751 for the flight to MO55 to drop off the medic, nurse and patient and a risk assessment total of low, which equated to 28; the flight request subtotal was 15 and the shift change subtotal was 13. Low risk was defined on the form to have a value of less than 30, and medium risk was defined with a value of 30-49. Item 3 of the form, pilot has less than 3,000 total rotor wing flight hours, which had a value of 4, was left blank.


AIRCRAFT 1 FINAL REPORT


The emergency medical service (EMS) helicopter was landing on a privately owned elevated heliport to pick up two medical crewmembers. The medical crewmembers had been dropped off with a patient on a preceding flight. During the preceding flight, the nurse thought about telling the pilot to abort the landing on the heliport because there was a lot of rolling and yawing, and he was having a hard time landing the helicopter. After the landing, the nurse and another medical crewmember stated that the pilot did not want to depart the heliport, but the medical crewmembers told the pilot that there may be potential arrivals of other EMS helicopters. The pilot chose to depart the heliport and obtained fuel at the operator's base of operations. For the return flight to pick up the two medical crewmembers, the wind had increased, and the helicopter approached the heliport in high-wind conditions and with a right, quartering tailwind. Also, the wind along with the surrounding buildings likely created a turbulent airflow/windshear environment in which the helicopter was operating as it approached for landing. The helicopter's operation in a high-power, low-airspeed condition in high-wind conditions, including a right quartering tailwind, likely resulted in a loss of control due to settling with power. A security video showed the helicopter on a northerly flightpath descending at about a 45-degree angle before impacting the ground and coming to rest on an approximate northerly heading. The pilot sustained fatal injuries due to the subsequent fuel tank fire/explosion, which otherwise would have been a survivable accident. A postaccident safety evaluation of the heliport showed that the final approach and takeoff area/safety area were obstructed by permanent and semi-permanent objects that pose a serious hazard to helicopter operations. These obstructions limited the available approach paths to the heliport, which precludes, at times, approaches and landings with a headwind. The helipad is privately owned; therefore, it is not subject to Federal Aviation Administration (FAA) certification or regulation. A review of the helicopter's flight manual revealed that there were no wind speed/azimuth limitations or suggested information available to pilots to base the performance capabilities of the make and model helicopter in their flight planning/decision-making process. Examination of the helicopter revealed no anomalies that would have precluded normal operation and showed engine power at the time of impact.


AIRCRAFT 1 CAUSE REPORT


The pilot's decision to land during unfavorable wind conditions, which resulted in a loss of control due to settling with power. Contributing to the accident were the lack of an adequate approach path due to numerous obstructions and the lack of available guidance regarding the helicopter's performance capabilities in the right quartering tailwind condition.

Friday, February 10, 2017

Remember Rebecca - Remember That It Is Okay To Say Stop...


"Weather overlays with the GPS track indicated that the helicopter made the 360° turn about the same time that an outflow boundary wave, which could have increased the potential for windshear and strong updrafts and downdrafts and reduced ceilings and visibility. Following the 360° turn, the helicopter proceeded toward the destination. About 14 minutes later, the helicopter turned right and began flying toward a major highway. It is likely that, due to the reduced visibility in the area, the pilot was flying toward the highway to follow the lights toward the city. The helicopter then turned further right and began to climb. As the helicopter entered another outflow boundary wave, it turned left. The left turn tightened, and the helicopter began to rapidly descend into terrain. The helicopter impacted a mesa in a near-level attitude."








Tuesday, January 3, 2017

First You Dream...

Recently we got into a philosophical discussion about what a rational mission-based HEMS structure would look like: as opposed to today's structure, which is partly market-based and partly based on struggles for market dominance.


"Who pays and does it cost the same for each airframe or is it funded differently?  Then the next question is about fees; or should it be a tax supported system.  I will say that a tax-supported system is something that I distrust. It would eventually look like the VA running our medevac community which would be more flawed than what we have now."

Jonathan Godfrey, Flight Nurse, Industry Expert, Co-Founder Survivor's Network for the Air Medical Community

I envision IFR twins at the metro hospitals, VFR or limited-IFR singles distributed evenly across the area, and at least one tilt-rotor per larger state, based near the geographic center, ready to respond to pad or runway, and able to leap vast distances with a single fuel load. As much as I favor free markets and respect the benefits of competition, I feel that naked ambition, greed, and fear-driven marketing strategies lead to waste and inefficiency.


 "I believe that it is one of the Scandinavian countries that has provider bid on contracts for areas of operation. This seems like a pretty sound plan to me. I agree with Jonathan we do not want US HEMS to become the "VA" however If we set up a system where companies have to bid on contracts it enables some quality control and sensible deployment of resources. Unlike today where it is a free for all." Sam Matta, Flight Nurse, Combat Veteran, Co-Founder East Coast Helicopter Organization (ECHO).

The IFR twins, with their larger cabins, are better suited to transporting pediatric and neo-nate teams from the hospital to the kids, and then everyone back to definitive care.

"Couldn't it work like other public service utilities? Or like the public/private partnerships the fire service employs in many locations? It seems that the pure open market we have now creates a competitive situation that is also bad for safety."  Dr. Cathy Jaynes, Former director of research at The Center For Medical Transport Research. Former College Campus Chair at the University of Phoenix, Former Assistant Professor at The University of Colorado - Denver, Former Chief Flight Nurse at SkyMed.

The IFR twins can move adults when the weather grounds the singles out in the countryside. The singles can move patients in good weather, and are less costly to operate.

When Rocky Mountain Helicopters began to lose lucrative hospital contracts, they came up with the idea of the "Community Based" EMS helicopter, in which all staff work for the aviation provider. Thus was born LifeNet. This step got the helicopters away from the hospital, and put them out in the country where the patients are. Air Evac Lifeteam developed this model further, and experienced explosive growth. AEL provides rapid access to definitive care for millions of Americans. AEL looks for support from the communities they serve, and originated the idea of selling subscriptions. These subscriptions shield those transported from rapidly rising bills, now estimated to be in the range of $50,000 per flight. A subscriber is not liable for any costs beyond what his or her insurance company pays.

HEMS is, today, largely a fair-weather resource. In the advent of low ceilings and visibility, the vast majority of EMS helicopters are grounded. This is a tremendous weakness in the HEMS system, and the technology exists to overcome it. Today.

Tiered reimbursement, in which government payments would be adjusted to account for the costs of providing the transport, would help drive the industry towards - if not all-weather, at least adverse-weather capability. Instrument-flight-capable twin engine helicopters are much more expensive to operate, but beyond the increased safety and chance to capture more flight opportunities, there is no financial incentive to operate these more expensive machines. The ultimate capability to transport the ill and injured could be realized by use of a tilt-rotor. The tilt-rotor can operate around or above weather that will ground all the pure-helos. And it can best move patients interstate.

"Once you fly on a tiltrotor you realize that it cannot be compared to any helicopter. Its a turboprop that hovers while the helicopter is a helicopter with its limitations. God bless the tiltrotor. ....it has its place in EMS" Skip Robinson, Helicopter Industry Observer, Photographer, Author. 


Dr. Ira Blumen with the UCAN  Dauphin. Dr. Blumen led the
"Opportunities for Safety Improvement in Helicopter EMS" project.
Thanks to the knowledge and hard work of
people like Dr. Blumen, we have hope for a bright future for HEMS.

As Congress, the General Accounting Office, and the states come to grips with the issues facing HEMS and the health-care system; an understanding of where we are, how we got here, and where we might go in the future of HEMS will be key to sound decisions.

"(All this) sounds better than the race to the bottom we are in now but me thinks you're a dreamer." Tim Lilley, Pilot, 10 year HEMS veteran, MSM. 

 "Dreaming is critical! 😉"
Dr. Cathy Jaynes